What is Endometriosis?

/ Embody Health Centre/

Endometriosis is defined as a “heterogenous, estrogen-dependent, inflammatory disease characterized by the presence of endometrium-like tissue found outside of the uterus, primarily in the abdominopelvic cavity and ovaries”. Endometriosis is estimated to occur in 10-15% of menstruating individuals.

The exact cause of endometriosis is unknown.

Symptoms of endometriosis:

  • Abnormal or heavy menstrual flow

  • Pain in the abdomen or low back, during intercourse, with urination, and/or with bowel movements.

The amount of pain experienced does not directly correlate with the severity of endometriosis, however, pain does correlate to pelvic floor dysfunction.

When the nervous system receives pain signals from the pelvis and surrounding area, it can cause changes in the pelvic floor musculature. When these signals are more constant, such as with endometriosis, it can cause persistent contractions in these muscles, increasing the muscle tone in the back, abdomen, and pelvic floor muscles. This is called hypertonicity, meaning that the muscles are tighter than normal.

In a recent research study by Fraga and colleagues, they compared the pelvic floor musculature in individuals with endometriosis to those without, and found many notable differences. First, those with endometriosis were 28.75% more likely to have hypertonic pelvic floor muscles. They were also more likely to have weak voluntary contractions of the pelvic floor and more often used accessory muscles. Research also shows that individuals with endometriosis were 45% more likely to be unable to fully relax the pelvic floor. Finally, the endometriosis group had tighter muscles in their thighs and buttocks than the control group.

This new data suggests that endometriosis and the associated frequent pain changes the way the pelvic floor and surrounding musculature are able to function. In general, the pelvic floor muscles are tighter, weaker, and less able to relax in those with endometriosis. The surrounding muscles in the hips, buttocks, and legs are activated more often to assist the pelvic floor muscles, and they also tend to be tighter than in those without endometriosis.

However, these changes don’t need to be permanent. Pelvic Floor Physiotherapists can help reduce some of the symptoms associated with endometriosis, such as pain with intercourse or tampon use. They can also help with the muscular changes to the pelvic floor and surrounding muscles. By working on various exercises to relax and stretch the pelvic floor and external musculature, as well as working on strengthening these areas, one can start to retrain the pelvic floor to reduce pain and discomfort.

Pelvic Health Physiotherapists can help with endometriosis in many ways.

Endometriosis treatment:

  • Stretching and relaxing muscles surrounding the back, hips, and the pelvic floor muscles

  • Working on deep breathing and relaxation techniques

  • Strengthening the pelvic floor muscles

  • Addressing any pain with intercourse or tampon use

To book an appointment with our Pelvic Health Physiotherapist, Jessica, click here.


Reference:

Fraga, M.V., Oliveira Brito, L. G., Yela, D. A., Mira, T. A., & Benetti Pinto, C. L. (2021). Pelvic floor muscle dysfunctions in women with deep infiltrative endometriosis: An underestimated association. International Journal of Clinical Practice (Esher), 75(8), e14350–n/a. https://doi.org/10.1111/ijcp.14350